Social Security will be fine. Anyone who pisses in their pants about it is automatically disqualified from discussions of public policy. Not only is the demographic situation set to stabilize in the next few decades (the Baby Boomers won't live forever, and my generation is even more numerous), but the adjustments to the payroll tax and benefits need to sustain the system into the 22nd century are almost ludicrously small to anyone who's not in Congress, AARP, or an Ayn Rand fanboy club. FICA currently taxes 15.3% of a worker's income, split equally between employer and employee. The SSA projects that an increase of a little over 1 percent will be sufficient for decades, and that a benefit cut of 20% would do the same. Neither will happen, but a series of smaller tax increases and benefit cuts will, of necessity, be made in the next decade. It's the most popular program ever, pretty much, and when Congress is faced with achoice between making some small painful changes or the much more painful option of losing the system entirely, I know the result.
Medicare is in more trouble, but it has nothing to do with a government program. Insurance is all about risk pools, and Medicare's pool - the elderly - is the most risk-heavy you can imagine outside of the poor (Medicaid, which has its own problems). Medicare routinely receives higher marks for customer satisfaction than private insurance (so do the government-run Veterans' Administration and military medical program, for that matter), and it does it more efficiently than private insurers, due to its nonprofit status and lower overhead, which combine to eat up, on average, over 20% of industry revenue. (That's why the exhcnages in the bill mandate that participating programs spend at least 80 cents on the dollar on care, a standard that very few private group plans currently meet.) There are worse solutions to the health-care program than simply expanding Medicare into a system that includes younger, healthier workers, which is how it's done in most of the civilized world, with their low infant-mortality rates and high life expancies.
The most ineffecient aspect of Medicare? The Advantage program, which allows recipients to use their benefits to enroll in private insurance plans.
There aren't enough cost-controls in the bill for my taste (if you want to twist and not just bend the cost curve, you have to do something about delivery systems, something more than introducing bundled payments), but as it stands this is probably the single largest deficit-reduction measure ever considered.
I'm not sure why anyone is worked up over reconciliation. Remember, the Senate bill passed in December 60-40. The filibuster was defeated, and the bill passed under normal rules. Budget reconciliation is being used as it was always intended - to pass a series of budget amendments.
There is no public option in the bill that will become law, by the way; it was in the House version but not the Senate, and the current plan is for the House to deem the Senate bill passed when both houses vote on the amendments this week.
